不同FIGO分期子宫内膜癌患者外周血红细胞分布宽度、血清对氧磷酶-1表达水平差异及其诊断价值分析

摘要 目的：探讨不同国际妇产科学联合会（FIGO）分期子宫内膜癌患者外周血红细胞分布宽度（RDW）、血清对氧磷酶-1（PON-1）表达水平差异及其诊断价值。方法：选取我院2018年1月到2020年1月收治的80例子宫内膜癌患者作为研究对象，根据FIGO分期对所有患者进行分组，分为Ⅰ期组23例，Ⅱ期组22例，Ⅲ期组18例，Ⅳ期组17例。另选取同期来我院体检的30名健康志愿者作为对照组，对比所有受检者RDW、PON-1表达水平，并应用ROC曲线分析外周血红细胞分布宽度、血清对氧磷酶-1表达水平对不同FIGO分期子宫内膜癌的诊断价值。对80例子宫内膜癌患者进行2年随访，将2年内死亡的25例患者分为死亡组，将其余55例患者分为存活组，对比死亡组与存活组临床一般情况与RDW、PON-1表达水平，并应用logistic回归分析分析RDW、PON-1对子宫内膜癌的预后预测价值。结果：五组受检者RDW、PON-1水平对比差异显著，Ⅳ期组RDW水平高于Ⅲ期组、Ⅱ期组、Ⅰ期组和对照组，Ⅳ期组PON-1水平低于Ⅲ期组、Ⅱ期组、Ⅰ期组和对照组（P＜0.05）；RDW结合PON-1联合诊断的准确度、敏感度、阳性预测值高于RDW单一诊断和PON-1单一诊断（P＜0.05）。RDW诊断子宫内膜癌不同分期价值曲线下面积为89.63，最佳诊断着色界限值为75.73 %，PON-1的曲线下面积为78.89，最佳诊断着色界限值为82.53 %，两者联合的曲线下面积为84.26，最佳诊断着色界限值为87.57 %；存活组与死亡组患者性别、年龄、病理类型对比无明显差异（P＞0.05），两组患者FIGO分期、基层浸润、组织分化程度、血清RDW与PON-1表达水平对比差异显著（P＜0.05）；logistic回归分析结果表明：基层浸润、RDW与PON-1为子宫内膜癌患者预后的独立影响因素（P＜0.05）。结论：RDW、PON-1联合对子宫内膜癌FIGO分期的诊断价值较高，且基层浸润、RDW与PON-1为子宫内膜癌患者预后的独立影响因素。临床上需针对基层浸润、RDW升高与PON-1水平降低的患者采取相关措施，改善治疗方案，降低患者死亡率情况。

Analysis of the Differences in the Distribution Width of Peripheral Blood Red Blood Cells and the Expression Level of Serum Paraoxonase-1 in Patients with Endometrial Carcinoma at Different FIGO Stages and Their Diagnostic Value

ABSTRACT Objective: To investigate the difference of RDW and PON-1 expression in peripheral blood of patients with endometrial cancer in different FIGO stages and analyze their diagnostic value. Methods: 80 patients with endometrial cancer admitted to our hospital from January 2018 to January 2020 were selected as the study objects. All patients were divided into three groups according to FIGO stage: 23 patients in stage I group, 22 patients in stage II group, 18 patients in stage III group, and 17 patients in stage IV. In addition, 30 healthy volunteers who came to our hospital for physical examination at the same time were selected as the matched group to compare the expression levels of RDW and PON-1 of all subjects. The distribution width of peripheral red blood cells and the expression level of serum paraoxonase-1 were analyzed by using the ROC curve to determine the diagnostic value of endometrial cancer in different FIGO stages. 80 patients with endometrial cancer were followed up for two years. 25 patients who died within two years were divided into death group, and the remaining 55 patients were divided into survival group. The general clinical conditions, RDW and PON-1 expression levels in death group and survival group were compared. The prognostic value of RDW and PON-1 in endometrial cancer was analyzed by logistic regression analysis. Results: The levels of RDW and PON-1 in five groups were different. The level of RDW in Phase IV group was higher than that in Phase III group, Phase II group, Phase I group and matched group, while the level of PON-1 in Phase IV group was lower than that in Phase III group, Phase II group, Phase I group and matched group(P<0.05); The accuracy, sensitivity and positive predictive value of combined diagnosis of RDW and PON-1 were higher than those of single diagnosis of RDW and PON-1 (P<0.05). The area under the value curve of different stages of endometrial cancer diagnosed by RDW was 89.63, the optimal diagnostic color limit value was 75.73 %, the area under the curve of PON-1 was 78.89, the optimal diagnostic color limit value was 82.53 %, the area under the curve of the combination of RDW and PON-1 was 84.26, and the optimal diagnostic color limit value was 87.57 %; There was no difference in sex, age and pathological type between the survival group and the death group (P>0.05). There was difference in FIGO stage, grassroots infiltration, tissue differentiation, serum RDW and PON-1 expression between the two groups(P<0.05); The above indicators with statistical differences in univariate analysis were assigned. The results of logistic regression analysis showed that grass-roots infiltration, RDW and PON-1 were independent prognostic factors for endometrial cancer patients (P<0.05). Conclusion: The combination of RDW and PON-1 has a high diagnostic value in FIGO staging of endometrial carcinoma, and grass-roots infiltration, RDW and PON-1 are independent prognostic factors of endometrial carcinoma. In clinical practice, relevant measures should be taken for patients with grass root infiltration, increased RDW and decreased PON-1 level to improve the treatment plan and reduce the mortality of patients.